In long-term care, a five-star rating often serves as a badge of honor. It’s a symbol of quality, a mark of distinction that suggests your facility is among the best. But what if that coveted rating isn't telling the whole story? What if, despite your facility's stellar reputation, you're missing out on significant revenue due to gaps in your Minimum Data Set (MDS) process? At SMK Medical, we frequently encounter facilities that, despite their high ratings, are losing thousands of dollars due to overlooked details in their MDS assessments. In this article, we’ll explore why a five-star rating might not be enough to secure your revenue and how a thorough review of your MDS process could reveal critical opportunities for financial improvement.

Understanding MDS Assessments

The MDS assessment is a crucial tool in the long-term care industry, serving as a comprehensive assessment tool that captures a resident's health and functional status. It is used not only for care planning but also as a key component in determining reimbursement rates under the Patient-Driven Payment Model (PDPM). The accuracy and completeness of these assessments directly impact your facility’s financial health. Errors or omissions in the MDS process can lead to significant revenue losses, even if your facility has earned a high rating.

The Impact of a Five-Star Rating on Revenue

While a five-star rating is undoubtedly a significant achievement, it does not guarantee optimal revenue. Many facilities assume that a high rating automatically translates into financial success, but this is a misconception. The reality is that the MDS process plays a critical role in determining your reimbursement rates, and even minor errors can lead to substantial revenue losses. It’s essential to recognize that while quality ratings are important, they are only one piece of the puzzle.

Critical MDS Areas That Affect Revenue

Several areas within the MDS process can have a direct impact on your facility’s revenue. These include:

• ICD-10 Coding Errors: Accurate coding is essential for ensuring that your facility receives the appropriate reimbursement. Errors in ICD-10 coding can lead to underpayment or even denial of claims.
• Inaccurate Assessment Reference Dates (ARDs): The ARD is a critical date that affects the entire MDS process. If this date is incorrect, it can lead to inaccurate assessments and lost revenue.
• Missed Non-Therapy Ancillary (NTA) Points: NTA points are a key component of PDPM reimbursement. Missing out on these points can significantly reduce your facility’s revenue.

Hidden Pitfalls in the MDS Process

Beyond the more obvious areas, there are several hidden pitfalls in the MDS process that can lead to revenue loss:

• Overlooked Physician Certifications: Physician certifications are a critical component of the MDS process. Failing to secure these certifications can result in compliance issues and lost revenue.
• Qualifying Stays: Ensuring that all stays meet the necessary qualifications for reimbursement is essential. Missed qualifications can lead to denied claims and reduced revenue.
• Documentation Errors: Proper documentation is vital for supporting the MDS assessments. Incomplete or inaccurate documentation can result in reduced reimbursement rates.

The Importance of Accurate ICD-10 Coding

ICD-10 coding is a complex but crucial aspect of the MDS process. Common coding mistakes, such as incorrect sequencing or missing codes, can have serious financial consequences for your facility. Ensuring that your staff is properly trained and that your coding processes are regularly audited can help mitigate these risks and ensure that your facility is maximizing its reimbursement potential.

ARD Dates: The Overlooked Factor

The Assessment Reference Date (ARD) is a key component of the MDS process. This date determines the timing of the assessment and influences the entire reimbursement process. Inaccurate ARD dates can lead to significant errors in the MDS assessments, resulting in lost revenue. Implementing best practices for determining and verifying ARD dates is essential for ensuring accurate and complete assessments.

Non-Therapy Ancillary (NTA) Points: A Revenue Driver

NTA points are a critical element of the PDPM reimbursement model. These points are based on the presence of certain conditions and services that require additional resources. Ensuring that your facility is accurately capturing all eligible NTA points is essential for maximizing your revenue. This requires a thorough understanding of the conditions and services that qualify for NTA points and careful documentation to support their inclusion in the MDS assessment.

Case Study 1: The Certification Disaster

In a recent audit, SMK Medical uncovered a major issue at a facility where the MDS team had failed to secure physician certifications for nearly 90 Medicare admissions. This oversight not only posed a significant compliance risk but also represented a substantial financial loss. By identifying and addressing this issue, we were able to help the facility avoid further losses and ensure that future certifications were secured in a timely manner.

Case Study 2: The Respiratory Revenue Leak

Another facility we worked with was missing out on crucial respiratory NTA points due to incomplete documentation. This oversight was not only costing the facility in terms of lost revenue but also jeopardizing their compliance standing. After conducting a thorough audit, we identified the gaps in their documentation process and implemented solutions to ensure that all eligible NTA points were captured in future assessments.

SMK Medical’s Free MDS Revenge Assessment Audit

At SMK Medical, we offer a comprehensive MDS Revenge Assessment Audit designed to uncover the gaps that are bleeding your facility dry. This free audit examines every aspect of your MDS process, from ICD-10 coding to documentation and physician certifications. Our goal is to identify the areas where your facility is losing revenue and provide actionable recommendations to address these issues.

48 Hours to Nurse: Fast-Tracking MDS Assessments

One of the unique services we offer is our 48 Hours to Nurse guarantee. From the moment you sign with us, we commit to assigning an MDS nurse to your facility within 48 hours. This rapid response ensures that your assessments are completed on time, reducing the risk of errors and missed revenue opportunities.

The Role of Remote MDS Services in Revenue Optimization

In today’s digital age, remote MDS services offer a flexible and efficient solution for optimizing your facility’s MDS process. We provide remote education and training for your staff, remote auditing to identify and address issues, and remote MDS completion to ensure that your assessments are accurate and timely. These services are designed to help your facility maximize its revenue while minimizing the risk of errors and compliance issues.

Ready to Secure Your Revenue? Take Action Today

Don't let an incomplete MDS process drain your facility's profits. At SMK Medical, we're here to help you turn potential losses into gains with our Free MDS Revenge Assessment Audit. Our team of experts will dive deep into your current processes, identify where you're losing money, and provide actionable solutions to maximize your revenue.

Get started now! Visit PDPMHelp.com or call 313-324-8267 to schedule your Free MDS Revenge Assessment Audit. Plus, take advantage of our 48 Hours to Nurse guarantee—ensure that your facility is always compliant and never missing a single assessment.

Every day you wait could be costing you thousands. Let SMK Medical transform your Quality Measures into revenue-generating machines.

Disclaimer:

The information provided on this blog by SMK Medical is for general informational purposes only. We are not liable for any actions that were taken based on the information provided. Please consult with a qualified professional for specific advice.